Skip Navigation Links
U.S. flag An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Advanced Visualization Branch

Nursing research has the capacity to inform the design of effective interventions for people facing homecare challenges through understanding the ways in which environments support or interfere with self-management.

The Advanced Visualization Branch (AVB) develops and evaluates advanced visualization environments, particularly immersive virtual reality (VR), to study in depth the ways people carry out instrumental activities of daily living, the impact of cognitive challenges and distractors on performance, and the manner in which observations may complement or supplant self-report indicator of performance.

  • AVB Lab 1
  • AVB Lab 2
  • AVB Lab 3


AVB Staff Profiles

Dr. Patti BrennanAdjunct Investigator: Dr. Patti Brennan

The AVB lab develops interactive virtual reality simulations that present health information to patients with a variety of complex health conditions. These simulations enable patients to rehearse problem-solving behaviors to foster improved health outcomes within home-based care environments. This research also seeks to define methodologies for AR/VR technology as a health tool to aid disease-management nursing strategies in the transition from acute care settings to outpatient environments. Additionally, this research seeks to identify recommendations for how to best deliver this type of technology to patients.


Jim Holdnack

Current Work

Jim Holdnack joined the NINR AVB as a staff scientist in August of 2019. He is responsible for managing the daily operation of the lab, development of research protocols, data analysis, research dissemination, collaborations and design of tasks and environments for immersive VR research studies. His research interests are in the measurement of individual differences in human behavior in response to immersive VR environments. Currently, he is working on the implementation of a protocol to study cognitive fatigue induced by completing an instrumental activity of daily living (e.g. grocery shopping). This study seeks to identify cognitive and environmental factors that promote fatigue in healthy controls. Subsequent studies will evaluate factors associated with cognitive fatigue in clinical populations. Other projects include studying cognitive factors related to medication management and grocery shopping for individuals with health-related dietary restrictions. 

Past Research Focus

Dr. Holdnack has extensive experience in cognitive and behavioral test development, validation and clinical translation. He worked as a researcher and consultant to the largest global publisher of commercial psychological tests for over 20 years.  He developed hundreds of tests, thousands of test scores, score reports, and interpretative reports for neuropsychological and cognitive ability batteries routinely used in clinical practice. He has expertise in the adaptation, design and developmental of digital cognitive measures. As part of his work in psychological test development, he created and implemented large normative, validation, clinical, and reliability studies involving tens of thousands of healthy controls and individuals with neurological, neuropsychiatric, and neurodevelopmental conditions. Dr. Holdnack has experience in psychometric methods, applied statistics, sampling and normative techniques.


  • Two-years Post Doctoral Fellowship (Neuropsychology), University of Pennsylvania Medical School Philadelphia, PA
  • PhD (Counseling Psychology), State University of New York at Buffalo, Buffalo NY
  • Bachelor of Arts (Social Science), Gannon University, Erie PA


  • Nelson Butters Award for Research Contributions to Clinical Neuropsychology presented by National Academy of Neuropsychology, October, 2008

Selected Publications

  • Iverson, G. L., Karr, J. E., Terry, D. P., Garcia-Barrera, M. A., Holdnack, J. A., Ivins, B. J., & Silverberg, N. D. (2020). Developing an Executive Functioning Composite Score for Research and Clinical Trials. Archives of Clinical Neuropsychology. doi: 10.1093/arclin/acz070
  • Karr, J. E., Garcia-Barrera, M. A., Holdnack, J. A., & Iverson, G. L. (2019). The Other Side of the Bell Curve: Multivariate Base Rates of High Scores on the Delis-Kaplan Executive Function System. Journal of the International Neuropsychological Society, 1–12. doi: 10.1017/s1355617719001218
  • Holdnack, J.A., Tulsky, D.S., Brooks, B.L., Slotkin, J., Gerson, R., Heinemann, A. W. & Iverson, G.L. (2017). Interpreting patterns of low scores on the NIH toolbox cognition battery. Archives of Clinical Neuropsychology. doi:10.1093/arclin/acx032 
  • Holdnack, J.A., Iverson, G.L., Silverberg, N.D., Tulsky, D.S., & Heinemann, A. W. (2017). NIH toolbox cognition tests following traumatic brain injury: Frequency of low scores. Rehabilitation Psychology,  62,474-484. 
  • Holdnack, J.A., Tulsky, D., Heaton, Slotkin, J., Tyner, C.E., Gerson, R., Iverson, G.L., & Heinemann, AW.  (2017). NIH Toolbox Premorbid Ability Adjustments: Application in a Traumatic Brain Injury Sample. Rehabilitation Psychology, 62, 496-508.

Recent Books and Chapters

  • Weiss, L. G., Saklofske, D. H., Holdnack, J. A., & Prifitera, A. (2019). WISC-V clinical use and interpretation. London, United Kingdom: Academic Press.
  • Holdnack, J.A. (2019). The development, expansion, and future of the WAIS-IV as a cornerstone in comprehensive cognitive assessments In Goldstein, G., Allen, D. N., & DeLuca, J (Eds.). Handbook of psychological assessment. London: Academic Press.
  • Drozdick, L.W., & Holdnack, J.A. (2017). Wechsler Memory Scale. In A. Wenzel (Ed.), The SAGE encyclopedia of abnormal and clinical psychology. Thousand Oaks, CA: SAGE Publications.

Recent Patents

  • Delis, D., Holdnack, J.A., & Drozdick, L.W. (2020). Multi-Level Executive Functioning Tasks. US Patent: 10,646,172.
  • Wahlstrom, D. Breaux, K, Holdnack, J., & Weiss (2020) Diagnostic Analyzer for content receiver using wireless execution device. US Patent: 10548035B2

Editorial Boards

  • Journal of Psychoeducational Assessment (2016-present)
  • Psychological Assessment (2016-present)

Denise Goldsmith

Current Work

Denise Goldsmith has extensive experience as a clinical informatics specialist. Her research has focused on using innovative technology to improve the care of patients in both hospital and home settings. Denise provides a nursing foundation to the AVB and connects the team with experienced home care nurses who identify patient's self-care management issues important to our work. She develops and validates the clinical scenarios chosen to study in our VR environment. Previous experience includes:

  • Chief Nursing Informatics Officer, Brigham and Women's Hospital, Boston
  • Director, Clinical Informatics and Chief Privacy Officer, Clinician Support Technology, Boston
  • Douglas Porter Fellow in Informatics, Center for Clinical Computing, BIDMC & Harvard Medical School, Boston


  • Master of Public Health (MPH), Harvard T.H. Chan School of Public Health, Boston, MA
  • Master of Science (MSN), Boston University, Boston, MA
  • Bachelor of Science (BSN), Northeastern University, Boston, MA

Selected Publications

  • Goldsmith D, Bavuso K, Lagor C, Collins S. Adoption of Nurse Facing Clinical Decision Support Following EHR Implementation. AMIA Symposium, 2016: 57-58. PMID: 27437036  PMCID: PMC4941835  DOI: 10.4338/ACI-2015-10-RA-0128
  • Dykes P, DaDamio R, Goldsmith D, Kim H, Ohashi K, Saba V.  Leveraging standards to support patient-centric interdisciplinary plans of care. AMIA Symposium, 2011:356-63. PMID: 22195088 
  • Goldsmith D, Boomhower M, Lancaster D, Antonelli M, Murphy Kenyon M, Benoit A, Chang F, Dykes P. Development of a Nursing Handoff Tool (NHT): A Web-Based Application to Enhance Patient Safety. AMIA Symposium Proceedings, 2010. PMID: 21346980   PMCID: PMC3041387
  • Kim H, Choi J, Thompson S, Meeker L, Dykes P, Goldsmith D, Ohno-Machado L.. Automating pressure ulcer risk assessment using documented patient data. Int J Med Inform. 2010 Dec;79(12):840-8. PMID: 20869303
  • Dykes PC, Kim HE, Goldsmith DM, Choi J, Esumi K, Goldberg HS. The adequacy of ICNP version 1.0 as a representational model for electronic nursing assessment documentation. J Am Med Inform Assoc. 2009 Mar-Apr; 16(2):238-46. PMID: 19074298 
  • Kim H,  Dykes P, Goldsmith D, Mar P, Choi,J, Goldberg H. Towards a standardized representation to support data reuse: representing the ICNP semantics using the HL7 RIM. Studies in health technology and informatics 02/2009; 146:308-13. PMID: 19592855
  • Goldsmith DM, Kim HE, Choi J, Goldberg HS, Dykes PC. Representing nursing assessment documentation with ICNP. AMIA Annu Symp Proc. 2008 Nov 6:954. PMID: 18999149
  • Goldsmith D, McDermott D, Safran C. Improving cancer related symptom management with collaborative healthware. Medinfo 2004, Proceedings of the 11th World Congress on Medical Informatics: 217-21.
  • Goldsmith D, Silverman LB, Safran C. Pediatric Cancer CareLink: Supporting home management of childhood leukemia. Proc. AMIA Fall Symposium, 2002. PMID: 12463833 
  • Goldsmith D, Davis RB, Safran C. Using Just-in-Time Education to Enhance the Outcomes of Care. In One Step Beyond: The Evolution of Technology and Nursing. V Saba, R Carr, W Sermeus, P Rocha, (eds.), 2000. Auckland: Adis International Limited, 88-95.
  • Goldsmith D, Safran C. Using the web to reduce postoperative pain following ambulatory surgery. Proc. AMIA Fall Symposium, 1999 PMID: 10566466
  • Goldsmith D. Nursing and the Internet. MD Computing. 1998, 15:4,249-251.
  • Goldberg H, Goldsmith D, Law V, Keck K, Tuttle M, Safran C. An evaluation of UMLS as a controlled terminology for the problem list toolkit. MedInfo 98, Proc Eighth World Conference on Medical Informatics.

Donald Bliss

Current Work

Creation of 3D groceries for a virtual store, enhancement of the virtual environment with store branding and non-grocery additions to better induce presence. Development of videographics to promote the lab and our work.

Research Interests
Uses of Artificial Reality/Virtual Reality in education


  • Master of Art (Biological and Medical Illustration), Johns Hopkins School of Medicine


Katelyn Snell

Current Work

The creation of 3D elements for the virtual reality test store for cognitive fatigue and subsequent research into sodium intake.

Research Interests
Visual Applications, New Media Technology, Pressure Ulcer Prevention


  • Master of Art (Biomedical Communication/Medical Illustration), The University of Texas Southwestern Medical Center (UTSW)
  • Bachelor of Fine Arts (Scientific Illustration), The University of Georgia

Selected Publications

  • Molyneaux, Wes. How We See (An Interactive “EyeBook”), First Edition. 2019. 
  • Divers, Stephen J. Mader’s Reptile and Amphibian Medicine and Surgery, Third Edition. 2018; 81: 905
  • Hoffman, Barbara L. Williams Obstetrics, 24th Edition. Mc-Graw Hill Education. 2014. “Acrania/Anencephaly”. “Left Ventricular Outflow Tract View”. “Ventral Wall Anomalies”.

Ross Tredinnick

Current Work

Assisting with software development of 3D virtual environments for research projects 

Research Interests
Virtual Reality, Augmented Reality, Point Cloud Rendering, Informal STEM Learning


  • Master of Science (Computer Science), University of Minnesota

Selected Publications

  • Jolliff, A. F., Hoonakker, P., Ponto, K., Tredinnick, R., Casper, G., Martell, T., & Werner, N. E. (2020). The desktop, or the top of the desk? The relative usefulness of household features for personal health information management. Applied Ergonomics, 82, 102912.
  • Tredinnick, R., Cors, R., Madsen, J., Gagnon, D., Bravo-Gallart, S., Sprecher, B., & Ponto, K. (2020). Exploring the Universe from Antarctica-An Informal STEM Polar Research Exhibit. Journal of STEM Outreach, 3(1), 1-13.
  • Brennan, P. F., Ponto, K., Casper, G., Tredinnick, R., & Broecker, M. (2015). Virtualizing living and working spaces: Proof of concept for a biomedical space-replication methodology. Journal of biomedical informatics, 57, 53-61.
  • Tredinnick, R., Broecker, M., & Ponto, K. (2015, March). Experiencing interior environments: New approaches for the immersive display of large-scale point cloud data. In 2015 IEEE Virtual Reality (VR) (pp. 297-298). IEEE.

Sara Flash

Current Work

Development of pilot studies using virtual reality to test decision-making of patients learning to shop with diet-restrictions. Collaborating on data collection for a cognitive fatigue study. Selected as participant in the NIH Academy Fellows Program, a program designed to provide education and training in topics related to health disparities.

Research Interests
Memory, Behavioral interventions, Virtual Reality, Cognition, Decision-Making


  • Bachelor of Science (Neuroscience, Minor in Public Health), Muhlenberg College

Selected Publications and Achievements

  • Poster Presentation, Society for Neuroscience Conference, Chicago, IL
  • Flash, S., Barhoum, S., Dengler, J., Shah, K., Castillo, V., & Hansen Gotthard, G. Differential effects of visuospatial interference on consolidation of emotional and neutral episodic-like memory in virtual reality

Alexandra Cuc

Current Work

Alex is playing a key role in the development of pilot studies for upcoming AVB projects, including research and design of studies. 

Research Interests
Cognitive Behavioral Therapy, Behavioral interventions, Virtual Reality, Decision-Making


  • Research Assistant for Very Real Help, a company offering peer-based intervention using Cognitive Behavioral techniques through VR
  • Honors dissertation (in progress) - study on decision making in giving behavior
  • Past Research: Analyzing healthcare data from patients with chronic illnesses in UChicago biomedical department

La Ronda Elliott

Current Work

La Ronda is the Administrative Officer for the Advanced Visualization Branch.

Arrow Up Back to Top